Healthcare Provider Details

I. General information

NPI: 1922243567
Provider Name (Legal Business Name): DESIREE NICHOLE HAUENSTEIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DESIREE RETTIG

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10401 SAWMILL PKWY
POWELL OH
43065-7451
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-685-2805
  • Fax: 614-293-1957
Mailing address:
  • Phone: 614-685-2805
  • Fax: 614-293-1957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.002884RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.002884
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: